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PubMed2005

Who reports sexual function problems? Empirical evidence from Britain's 2000 National Survey of Sexual Attitudes and Lifestyles.

OBJECTIVE: To identify sociodemographic, sexual, and health behavioural and attitudinal factors associated with reporting sexual function problems. METHODS: A probability sample survey of 11 161 men and women aged 16-44 years resident in Britain in 2000. Data collected by a combination of computer assisted face to face and self interviewing. Outcomes were self report of a range of sexual function problems, considered as "any problems" (1+ lasting 1+ months in the past year) and "persistent problems" (1+ lasting 6+ months in the past year), and associations with sociodemographic, behavioural, and attitudinal variables. RESULTS: Both "any" and "persistent" sexual function problems were more commonly reported by women than men. A variety of sociodemographic factors were associated with both measures but differed by gender. For example, the adjusted odds ratio (AOR) for reporting any problems for married v single respondents was 0.70 (95% confidence interval (CI) 0.57 to 0.87) v 1.31 (95% CI 1.10 to 1.56) for men and women, respectively. Sexual behaviours significantly associated with reporting sexual function problems included competence at first sex, paying for sex in the past 5 years, number of occasions of sex and masturbation, both in the past 4 weeks. For men (only), reporting STI diagnosis(es) was significantly associated with reporting "any" problems (AOR 2.1, 95% CI 1.4 to 3.2) and "persistent" problems (AOR 2.1, 95% CI 1.1 to 3.9). Both measures were significantly more likely among men and women who reported communication difficulties with their partners, with AORs in excess of 1.9. CONCLUSIONS: Sexual fulfilment is an important part of sexual health. Understanding factors associated with reporting sexual problems, and recognising that such factors maybe partnership specific, is an important step towards improving our understanding of sexual function and thus improving the provision of care and support available.

Adolescent↗
PubMed2002

Sexually transmitted infections in Bangladeshis resident in the UK: a case-control study.

OBJECTIVE: To evaluate the prevalence of sexually transmitted infections (STIs) and mode of presentation in patients originating from Bangladesh and resident in the United Kingdom in comparison with non-Bangladeshi patients attending an inner London genitourinary medicine (GUM) clinic. METHODS: A retrospective, cross sectional study with comparator group was carried out at an open access GUM clinic in east London. 104 consecutive newly attending Bangladeshi men were compared with 199 consecutive newly attending non-Bangladeshi men and 115 consecutive newly attending Bangladeshi women were compared with 218 consecutive newly attending non-Bangladeshi women. Any diagnosed sexually transmitted infections, sexual history characteristics, reasons for presentation, and referral patterns were noted. RESULTS: Bangladeshi men (28.8% compared with 7.5%; p<0.0001) and women (42.7% compared with 12.8%; p<0.0001) were more likely to be referred by their general practitioners or other medical services. Bangladeshi men were more likely to present with sexual dysfunction (12.5% compared with 2.5%; p=0.001). The prevalence of STIs was broadly similar across the study groups; however, syphilis was significantly more common in the Bangladeshi men (10.9% compared with 4%; p=0.04) and nongonococcal urethritis (NGU) in the control men (35% compared with 20.2%; p=0.02). Bacterial vaginosis was an infrequent diagnosis in the Bangladeshi women (3.5% compared with 22.4%; p<0.0001). CONCLUSIONS: STI prevalence in Bangladeshis attending GUM services is similar to other populations although patterns of presentation and referral do show variation. Bangladeshi men are more likely to access GUM clinics for psychosexual services. The presence of STIs in Bangladeshis particularly those imported from Bangladesh provides an opportunity for HIV transmission between the United Kingdom and Bangladesh.

Adolescent↗
PubMed2005

A survey of sexual and reproductive health in men with cystic fibrosis: new challenges for adolescent and adult services.

BACKGROUND: Improved survival dramatically alters the consequences of adult co-morbidities in men with cystic fibrosis (CF) such as male infertility. Few studies have systematically addressed the impact of sexual and reproductive health issues in these men or considered the implications for healthcare delivery. METHOD: A descriptive cohort study was undertaken using a sexual and reproductive health survey of men from a large adult CF centre, including men with lung transplantation. RESULTS: The mean (SD) age of the 94 men (response rate 75%) was 30.5 (7.6) years. 94% knew that men with CF had reduced fertility. Men first heard about infertility later than desired (p<0.001) and only 53% heard from their preferred source. Men who were told about infertility when older were more likely to be upset than those told earlier (p<0.01). 53% of men had undergone semen analysis: 68% of men who had not been tested wanted semen analysis. 73% believed semen analysis should occur before 18, but the youngest age of testing was 24 years. In adolescence, one in three men had assumed they did not need to use condoms and one in 10 had confused infertility with impotence. 66% of men wanted more information on reproductive options and 84% wanted children. Seventeen men were parents by natural conception (n = 1), micro-epididymal sperm aspiration (n = 6), donor sperm (n = 9), and through step children (n = 1). CONCLUSIONS: Men with CF desire more sexual and reproductive health information. Earlier discussion of sexual and reproductive health is indicated in paediatric settings, and semen analysis should be routinely offered. In adult services greater discussion of reproductive health options is indicated.

Adolescent↗
PubMed2006

[Female sexual function and related factors].

OBJECTIVES: To appraise female sexual function and to describe the factors that most commonly accompany dysfunction. DESIGN: Transversal, descriptive study. SETTING: Primary care. PARTICIPANTS: Two-hundred and twenty-three women from 18 to 76 seen at an urban health centre between November 2004 and February 2005 and who wanted to take part in the study. MAIN MEASUREMENTS: These were collected in an anonymous questionnaire structured in 5 sections with 53 items. The questionnaire comprised social and economic, cultural and life-style variables; female sexual function (FSF); and perception of own state of health (SF-12). A binary logistical regression analysis was run. RESULTS: Female sexuality reaches its maximum expression at 30-35 years (FSF=30.0, 95% CI, 28.3-31.6). Risk factors for sexual dysfunction were: age over 44 and religion (OR, 6.5; 95% CI, 2.8-15); physical component on the SF-12 below 37 (OR, 3; 95% CI, 1.3-7.2); mental component on the SF-12 below 31 (OR, 3.1; 95% CI, 1.2-7.8). Not having a stable partner was a risk factor for arousal (OR, 9.6; 95% CI, 2.8-24.0); for lubrication (OR, 9.3; 95% CI, 4.0-21.5); for orgasm (OR, 8.8; 95% CI, 3.1-24.8); and for dyspareunia (OR, 8.9; 95% CI, 3.9-20.5). It was not a risk factor for desire or satisfaction with sexual life. CONCLUSIONS: The profile of sexual dysfunction consisted of a woman aged over 44 without a stable partner, who practised religion, was unemployed and had perception of low quality of life.

Adolescent↗
PubMed2004

Psychosocial factors and sexual dysfunctions: a descriptive study in Turkish males.

The study of human sexuality has dramatically changed in the last decade. The conceptualization of sexual dysfunction developed in the West is now mushrooming in different parts of the world and there is a dearth of research on characteristics of patients seeking treatment for sexual dysfunction in non-Western countries. This paper describes the demographic characteristics, related factors, and clinical symptomatology of 40 male patients with various sexual dysfunctions attending the psychiatric out-patient clinic of Cukurova University, Turkey. Turkey's population is predominantly Muslim and the country unites Europe and Asia, showing the cultural characteristics of both continents. Our results suggest that the patterns of manifestation are similar to those reported elsewhere with the exception of premarital patterns of sexuality.

Adult↗
PubMedDate not supplied

Sexuality at the end of life.

There is very little research literature that addresses sexuality at the end of life. Although end-of-life care has become a priority for nursing education, the issue of end-of-life sexuality is not included in the curriculum. Nurses are frequently in a position to establish relationships with couples that encourage a frank discussion and information sharing. As patient advocates, nurses can address end-of-life sexuality issues by taking a sexual history and implementing a general intervention model, such as the PLISSIT. Couples need to be reassured that if they have enjoyed a close sexual relationship, sexual intimacy may continue to be part of their relationship, even at the end of life.

Female↗
PubMedDate not supplied

Consequences of chemotherapy on the sexuality of patients with lung cancer.

Chemotherapy can cause a variety of physical and emotional changes that affect all aspects of patients' lives, including sexuality. Alterations in physical appearance can significantly influence people's perceptions of their sexual identities, attractiveness, and worthiness. Patients with lung cancer receiving chemotherapy may need sexual counseling. Therefore, patients and healthcare providers should create an environment that allows adequate time to discreetly discuss the impact that chemotherapy treatment may have on appearance, self-esteem, and sexuality. Nurses and physicians might hesitate to discuss sexuality with patients for various reasons, including time limitations, privacy considerations, readiness, and comfort level. Employers should provide support, educational programs, and professional resources so that healthcare providers can obtain the knowledge, develop the skills, and recognize that counseling patients about sexual issues is an important aspect in providing comprehensive holistic care to patients with lung cancer.

Antineoplastic Agents↗
PubMed2003

Patients' perceptions of quality of life after treatment for early prostate cancer.

PURPOSE: Treatment for early prostate cancer produces problematic physical side effects, but prior studies have found little influence on patients' perceived health status. We examined psychosocial outcomes of treatment for early prostate cancer. PATIENTS AND METHODS: Patients with previously treated prostate cancer and a reference group of men with a normal prostate-specific antigen (PSA) level and no history of prostate cancer completed questionnaires. Innovative scales assessed behavioral consequences of urinary dysfunction, sexuality, health worry, PSA concern, perceived cancer control, treatment decision making, decision regret, and cancer-related outlook. Urinary, bowel, and sexual dysfunction were assessed with symptom indexes; health status was assessed by the Physical and Mental Summaries of the Short Form (SF-12) Health Survey. RESULTS: Compared with men without prostate cancer, prostate cancer patients reported greater urinary, bowel, and sexual dysfunction, but similar health status. They reported worse problems of urinary control, sexual intimacy and confidence, and masculinity, and greater PSA concern. Perceptions of cancer control and treatment decisions were positive, but varied by treatment: prostatectomy patients indicated the highest and observation patients indicated the lowest cancer control. Bowel and sexual dysfunction were associated with poorer sexual intimacy, masculinity, and perceived cancer control; masculinity and PSA concern were associated with greater confidence in treatment choice; and diminished sexual intimacy and less interest in PSA were associated with greater regret. CONCLUSION: The lack of change in global measures of health status after treatment for early prostate cancer obscures important influences in men's lives; cancer diagnosis and treatment complications may result in complex outcomes. Aggressive treatment may confer confidence in cancer control, yet be countered by diminished intimate relationships and masculinity, which accompany sexual dysfunction.

Adult↗
PubMedDate not supplied

Speaking of sex: the need to dispel myths and overcome fears.

Myths and fears are intimately associated with issues of sex, sexuality and sexual health. Many myths and fears, present in both the education and clinical settings, prevent health carers from maximizing the potential for wholeness and wellness, for both themselves and their clients. In order for nurses, midwives and health visitors to take their role in therapeutic communication around the sex issues seriously, these myths must be dispelled and the fears overcome. Many of the hindrances to communication are shrouded in other people's taboos and morals, and hidden within the languages of clinical terminology and silence. This leads numerous clinicians and educators to an incommensurate fear of dealing with the sexual issues of life. This article argues that this is an example of institutionalized erotophobia (fear of sex), which results in a barrier to genuine, therapeutic, communication. For the sake of brevity, 'sex' will refer to sex, sexuality and sexual health. Likewise, unless a clear distinction is being made, 'nurse' will include midwives and health visitors.

Culture↗
PubMed2000

Sexuality in cancer and palliative care 1: Effects of disease and treatment.

All cancers and related treatments have the potential to affect sexuality and sexual function. This may result from impaired body function or altered body image, or from the emotional and psychological distress that often accompany diagnosis and treatment. It is increasingly acknowledged that issues surrounding sexuality are an important factor in quality of life for patients with cancer, and that sexuality is a legitimate area of concern for nurses in oncology and palliative care. However, issues relating to sexuality remain among the most poorly addressed in cancer care--possibly owing to lack of knowledge and expertise. There are also societal norms, myths and assumptions that may prevent nurses from broaching these issues. To provide this component of care, nurses need to have good communication skills, an open and non-judgmental approach, and knowledge of the potential ramifications of disease and treatment on sexuality.

Antineoplastic Agents↗
PubMed2001

Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding.

BACKGROUND: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. METHOD: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. RESULTS: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. CONCLUSIONS: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.

Adult↗
PubMed2005

Women's sexual dysfunction: revised and expanded definitions.

Acceptance of an evidence-based conceptualization of women's sexual response combining interpersonal, contextual, personal psychological and biological factors has led to recently published recommendations for revision of definitions of women's sexual disorders found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV-TR). DSM-IV definitions have focused on absence of sexual fantasies and sexual desire prior to sexual activity and arousal, even though the frequency of this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The revised definitions consider the many reasons women agree to or instigate sexual activity, and reflect the importance of subjective sexual arousal. The underlying conceptualization of a circular sex-response cycle of overlapping phases in a variable order may facilitate not only the assessment but also the management of dysfunction, the principles of which are briefly recounted.

Adult↗
PubMed2000

Sexuality and cancer: conversation comfort zone.

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Psychosocial issues profoundly affect patients with cancer. Of the many complexities that make up the psychosocial dynamic, perhaps the medical profession is most uncomfortable with sexuality. Many elements of sexual behavior remain high-profile taboos. A number of diseases and treatments significantly affect sexual function. Male and female sexuality were discussed in two separate rounds with an emphasis on how to begin a dialogue about sexuality without jeopardizing other aspects of the relationship with patients. Three cases were presented. A patient with prostate cancer considering treatment options for early-stage disease and two patients with gynecologic malignancies; one with a colostomy following cytoreductive surgery for ovarian cancer and the other with a failed vaginal reconstruction for recurrent squamous cell carcinoma of the vagina. Staff discussed the wide diversity of response to sexual dysfunction and the difficulties that patients face. A sensitive and informed approach to discussing sexuality can provide effective support. The elements of successful dialogue are presented in the PLISSIT model.

Adult↗